Laserfiche WebLink
1�,e MONITORING WELL INSTALLATION RF.,.OkT <br /> Date: • <br /> f CONSTRUCTION <br /> Premise Address: f � Total Depth a tq_ r <br /> Well No.: �/j _j j 3/��/per screen Length (from) 2 (to) r7 <br /> r Filter Pack (from) 2� (to — <br /> Inspector. &"ec e, i Bentonite (From) —(to-) <br /> Grout (from) (to)� <br /> ' f-01- <br /> -Drill ing rig type <br /> Permit No. / Auger O.D. I.D. <br /> 1 �-�N- Completion - Stove pipe/cluistie box (circle one) <br /> Drilling Company: <br /> Driller: �CkAq_V� ---_ casing <br /> ?` hezght <br /> Consultant b 1A.44.. , �� V <br /> Geologist i Gti✓h� ` <br /> ISO—/ /OY`p �L�` �L�� CO1Y lETlON G-(RZ7Y-i34X <br /> SPECIAL PERMIT INFO / G bh �o ;mcN <br /> Cir�urd Strtact <br /> Distance to server line Qrocrt <br /> Domestic well on site - (Y/ n ) <br /> Ii yes, location and distance <br /> ft. tt. <br /> — e <br /> SAMPLING — o <br /> ioc!cn :r = -� <br /> Holding Temperature <br /> Method — gna w wKX <br /> Screening Method <br /> Tracking Sheet - (y/ n ) — <br /> -..+ ,ft. <br /> ft. <br /> SPOILS <br /> Storage Method {�� MATERIALS EVELOPMENT <br /> Contamination Noted - (y <br /> Storage Location Casing type evc <br /> Blank ` ft- Screen (57 <br /> GR LMNNG Slot size <br /> Bags cement Wil{ CRv�w � <br /> fes, Buckets bentonite <br /> Depth to water f` T t� Bags sand/gravel ^ ' <br /> Mix Ratios Filter Pack type/size <br /> Installation Me[hod Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> EH 29 29 Type of method <br />